| NPI | 1346245164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL LL800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 0731) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2017-06-27 |